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Jørgensen TMM, Grauslund J, Sjølie AK, Green A, Rasmussen LM, Nybo M. Major diabetes-related vascular events do not improve glycaemic control in a population-based cohort of type 1 diabetic individuals. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 69:748-51. [PMID: 19929717 DOI: 10.3109/00365510903108410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE It is known that sudden serious events alter life styles related to treatment efficiency, as for example in cancer patients. However, it has not been specifically addressed if a first-time diabetes-related clinical event has impact on glycaemic regulation. We therefore assessed this in a population-based cohort of patients with long-term type 1 diabetes. METHODS This study was based on a cohort of type 1 diabetes patients with at least 20 years duration of diabetes. Of the 460 patients from the original cohort still alive at 1 January 1994, all patients with a major first-time diabetes-related clinical event (limb amputation, blindness, stroke, cardiac event, or panretinal photocoagulation) and glycated haemoglobin (HbA(1c)) measurements before, 3 and/or 12 months after the event were included. Differences in HbA(1c) measurements before and after the event were tested with Wilcoxon's test. RESULTS A total of 64 patients with a major clinical event between 1994 and 2006 entered the study. Mean HbA(1c) measurements decreased from 8.8% at baseline to 8.6% at 3 months and 8.7% after 12 months, a non-significant decrease. In all event groups, glycaemic regulation was unaltered in the majority of the patients. Only a minority worsened or improved their regulation, and in all groups only non-significant changes were seen. CONCLUSIONS Surprisingly, complication-related events did not improve glycaemic regulation in long-term type 1 diabetes patients. This is in contrast with the experience from other patient categories and shows how difficult it can be to alter glycaemic regulation in diabetes patients with stabilized disease.
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Affiliation(s)
- Trine Maria Mejnert Jørgensen
- Department of Biochemistry, Pharmacology and Genetics, Odense University Hospital, Sdr. Boulevard 29, Odense, Denmark
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2
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Smoking behavior postmyocardial infarction among ENRICHD trial participants: cognitive behavior therapy intervention for depression and low perceived social support compared with care as usual. Psychosom Med 2008; 70:875-82. [PMID: 18842753 DOI: 10.1097/psy.0b013e3181842897] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Patients with cardiovascular disease who stop smoking lower their risk of subsequent morbidity and mortality. However, patients who have suffered a myocardial infarction (MI) are more likely to be depressed than the general population, which may make smoking cessation more difficult. Poor social support may also make smoking cessation more difficult for some patients. This study examines the effect of cognitive behavior therapy (CBT) for depression, low perceived social support or both on smoking behavior in post-MI patients. METHODS Participants were 1233 patients with a history of smoking enrolled in the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) trial who provided 7-day point-prevalence smoking behavior information at baseline and at two or more follow-up assessments. The ENRICHD trial enrolled post-MI patients with depression, low perceived social support or both. Participants were randomly assigned to either CBT intervention or usual care. We used mixed effects models to accommodate data from multiple smoking point-prevalence measures for each individual participant. RESULTS CBT did not significantly reduce post-MI smoking across all intervention patients with a history of smoking. However, CBT did reduce post-MI smoking among the subgroup of depressed patients with adequate perceived social support (OR, 0.68; 95% CI, 0.47-0.98). CONCLUSION CBT for depression without more specific attention to smoking cessation may have little overall value as a strategy for helping post-MI patients refrain from smoking. However, use of CBT to treat depression may have the gratuitous benefit of reducing smoking among some post-MI patients.
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3
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Vernon JD, Crane LA, Prochazka AV, Fairclough D, MacKenzie TD. Smokers hospitalized in an urban, public hospital: addiction, stages of change, and self-efficacy. Prev Med 1999; 28:488-95. [PMID: 10329339 DOI: 10.1006/pmed.1998.0450] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study characterizes adult smokers on the medicine service of an urban, public hospital, including stage of change, self-efficacy to quit, and nicotine dependence, and explores relationships between perceived and actual smoking-related illness and these three predictive variables. METHODS Adult patients (n = 154) admitted to the Medicine service of Denver Health Medical Center in October and November 1996 were surveyed using a written questionnaire. RESULTS The proportion of smokers in this population was 45.7% (95% CI = 42.0%, 49.4%). Adjusted for age and sex, the proportion of smokers in this population was significantly greater than in Colorado (28.8% vs 21.8%, P < 0.001). About half (54.2%) were willing to try free nicotine patches during hospitalization. Among smokers with diseases recognized as smoking-related, 30.4% believed their reason for admission was related to smoking, compared to 20.4% among those with no smoking-related diseases (P = 0.18). Patients who believed their hospitalization was due to smoking had greater intentions (P = 0.001) and self-efficacy (P < 0.001) to quit. CONCLUSIONS Targeting smokers who perceive that their illness is smoking-related may optimize inpatient smoking interventions.
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Affiliation(s)
- J D Vernon
- University of Colorado Health Sciences Center, Denver, Colorado 80262, USA
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4
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Smit HJ, Chatrou M, Postmus PE. The impact of spontaneous pneumothorax, and its treatment, on the smoking behaviour of young adult smokers. Respir Med 1998; 92:1132-6. [PMID: 9926168 DOI: 10.1016/s0954-6111(98)90407-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The pneumothorax, and its often invasive treatment, are impressive events in otherwise healthy young patients. The relationship between smoking behaviour and the idiopathic spontaneous pneumothorax (ISP) is explained to the patients. The objective of the study was to analyse whether smoking behaviour of patients is influenced by the ISP (re-) event, and its treatment. Of 145 consecutive ISP patients (1991-1995), 112 were tobacco smokers at time of the first ISP. Of the 112, 106 participated in a confidential telephone questionnaire survey combined with retrospective medical record analysis. Smoking cessation and reduction percentage related to ISP events, and its treatment, were the outcome measurements. All patients (mean age 28.8 years at the first ISP) were aware of the relationship between smoking, and ISP at time of the first ISP. Age, pack years, and different treatment modalities had no influence on smoking cessation or reduction. Some 86.2% of the male and 80.8% of the female patients continued smoking after the first ISP, despite the known relationship between smoking, and contracting spontaneous pneumothorax, and despite its often invasive treatment. In the group of recurrent pneumothorax events 73.3% continued smoking.
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Affiliation(s)
- H J Smit
- Department of Pulmonary Medicine, Free University Hospital, Amsterdam, The Netherlands
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5
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Hasdai D, Garratt KN, Grill DE, Mathew V, Lerman A, Gau GT, Holmes DR. Predictors of smoking cessation after percutaneous coronary revascularization. Mayo Clin Proc 1998; 73:205-9. [PMID: 9511776 DOI: 10.4065/73.3.205] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify factors predictive of smoking cessation after successful percutaneous coronary revascularization. MATERIAL AND METHODS We undertook a case-control study of the smoking status of all patients at Mayo Clinic Rochester from September 1979 through December 1995 who were smokers at the time of an index percutaneous coronary revascularization procedure in the non-peri-infarction setting (no myocardial infarction within 24 hours). Maximal duration of prospective follow-up was 16 years. Patients were classified into those who permanently quit smoking immediately after the procedure (N = 435; mean follow-up, 5.1 +/- 3.7 years) or those who continued to smoke at some time during follow-up (N = 734; mean follow-up, 5.3 +/- 3.7 years). Logistics regression models were formulated to determine independent predictors of smoking cessation. RESULTS Predictors of continued smoking were greater prior cigarette consumption (odds ratio [OR] = 1.009 for each pack-year; 95% confidence interval [CI] = 1.004 to 1.014) and having one or more risk factors for coronary artery disease other than cigarette smoking (OR = 1.49; 95% CI = 1.15 to 1.93). Older age (OR = 0.98 for each additional year; 95% CI = 0.97 to 0.99) and unstable angina at time of initial assessment (OR = 0.69; 95% CI = 0.52 to 0.91) were associated with less likelihood of continued smoking. CONCLUSION Younger patients with a worse risk profile and greater prior cigarette consumption were more likely than other patients to continue smoking after percutaneous coronary revascularization in the non-peri-infarction setting. Patients who had unstable angina were more likely to quit smoking than those who had stable angina. Despite the proven benefits of smoking cessation after percutaneous coronary revascularization, a substantial proportion of smokers (63%) continue to smoke; thus, smoking-cessation counseling should be addressed in this population.
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Affiliation(s)
- D Hasdai
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA
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6
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Dresler CM, Bailey M, Roper CR, Patterson GA, Cooper JD. Smoking cessation and lung cancer resection. Chest 1996; 110:1199-202. [PMID: 8915221 DOI: 10.1378/chest.110.5.1199] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVE This study was designed to examine the extent of smoking cessation prior to thoracotomy for resection of a pulmonary malignancy and the recidivism rate. DESIGN Prospective, longitudinal study. PATIENTS All patients presenting to the General Thoracic Clinic. RESULTS The study included 362 patients, with an average age of 64.7 years; 95% with a smoking history were followed up for an average of 17.5 months. Five surgeons in the same practice group performed the procedures: pneumonectomy, 45; lobectomy, 288; and lesser resections, 29. Forty-two percent of patients had quit prior to 1 year; 6% quit 3 months to 1 year; 15% quit between 2 weeks to 3 months; 12% quit at 2 weeks; and 19% continued to smoke up to surgery. Postoperatively, 86% of previously smoking patients were nonsmoking; 13% of patients started smoking again. Of the restarted smoking patients, 61% had never quit preoperatively. Only 59% of smoking patients admitted that a physician had ever told them to stop smoking; however, 89% of patients who were smoking postoperatively acknowledged physician advice to stop smoking. CONCLUSIONS Long-term smoking cessation occurs in a large proportion of patients after resection of lung cancer. The longer the patient is nonsmoking preoperatively, the more likely he or she is to remain nonsmoking postoperatively. Conversely, patients who do not quit preoperatively are at significant risk of continuing to smoke postoperatively.
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Affiliation(s)
- C M Dresler
- Section of General Thoracic Surgen, Washington University School of Medicine, St. Louis, USA
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7
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Richmond RL. Retracing the steps of Marco Polo: from clinical trials to diffusion of interventions for smokers. Addict Behav 1996; 21:683-97. [PMID: 8904935 DOI: 10.1016/0306-4603(96)00028-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the results from a series of four controlled trials which evaluate efficacy, effectiveness, and implementation of interventions for smokers, and then discuss diffusion of our program in feasibility studies both nationally in Australia and internationally. In our first study we reported that when general practitioners delivered moderately brief advice to smokers, they have a 36% abstinence rate at three years. In the second study we found that doctors achieve a 12% abstinence at one year after giving minimal advice to patients, and when using a more involved intervention, quit rates of just less than 20% at one year. In the third and fourth studies of utilization of the smoking cessation program we report that reinforcement contact following a 2-hour training workshop increased doctors' use of a smoking cessation program at 6 months compared to no contact. The challenge of translating research findings into practice for the benefit of doctors in Australia as well as in a low-income country such as China, is described in two feasibility studies. Over the past 11 years we have disseminated the program nationally in Australia, and over 4500 doctors have been trained. Diffusion theory provides a useful model which has guided us in our implementation efforts in Australia and is being used to allow us to introduce the smoking cessation intervention for Chinese doctors to use.
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Affiliation(s)
- R L Richmond
- School of Community Medicine, University of New South Wales, Kensington, Australia
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8
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Haire-Joshu D, Ziff S, Houston C. The feasibility of recruiting hospitalized patients with diabetes for a smoking cessation program. DIABETES EDUCATOR 1995; 21:214-8. [PMID: 7758389 DOI: 10.1177/014572179502100309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aims of this study were to identify hospitalized smokers with diabetes, assess the severity of their physical condition, and determine their willingness to participate in a postdischarge smoking cessation program. Hospitalized smokers with diabetes were identified through referrals from the Dietetics Department. Smoking status was determined via medical charts, healthcare staff, and patient self-report. Among all patients with diabetes who were identified (n = 314), smoking status was routinely recorded only for those with a primary cardiac diagnosis (41%). Smokers (n = 59) were significantly younger and reported multiple but fewer concomitant diagnoses than nonsmokers. Ninety-one percent of the smokers who were contacted refused to participate in a postdischarge smoking cessation program. We conclude that accurate methods are needed for identifying all smokers to facilitate cessation efforts. The severity and chronicity of the physical condition of hospitalized smokers with diabetes may limit willingness to participate in a postdischarge smoking cessation intervention.
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9
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Mercelina-Roumans P, Breukers RB, Ubachs JM, van Wersch JW. Cord blood cells and indices: smoking-related differences between the sexes. Acta Paediatr 1995; 84:371-4. [PMID: 7795343 DOI: 10.1111/j.1651-2227.1995.tb13651.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The values of whole blood cell count, leucocyte differential, and platelet and reticulocyte counts were determined in cord blood of both male (n = 64) and female (n = 75) newborns of 87 non-smoking and 52 smoking mothers. Leucocytes and neutrophils in cord blood from the male newborns of smokers were significantly lower than those in their female counterparts and in male newborns of non-smokers. These results suggest that male newborns are more affected by cigarette exposure than females with regard to some haematological parameters.
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Affiliation(s)
- P Mercelina-Roumans
- Department of Obstetrics and Gynaecology, De Wever Hospital, Heerlen, The Netherlands
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10
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Ockene JK, Adams A, Pbert L, Luippold R, Hebert JR, Quirk M, Kalan K. The Physician-Delivered Smoking Intervention Project: factors that determine how much the physician intervenes with smokers. J Gen Intern Med 1994; 9:379-84. [PMID: 7931747 DOI: 10.1007/bf02629517] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine factors that affect how much physicians trained to use a patient-centered smoking intervention intervene with their smoking patients. DESIGN Forty internal medicine residents and ten internal medicine attending physicians trained in a patient-centered counseling approach were randomized to an algorithm condition (provision of intervention algorithm at each patient visit) or a no-algorithm condition. Smoking intervention steps used by physicians with patients were assessed with Patient Exit Interviews (PEIs). SETTING Ambulatory clinic; academic medical center. PATIENTS Five hundred twenty-seven adult smokers seen in clinic between June 1990 and April 1992. MAIN RESULTS There was no difference in overall PEI scores or in individual PEI steps taken between the algorithm and no-algorithm conditions. Two patient baseline factors (reporting thinking of stopping smoking within six months and higher Fagerstrom Tolerance Score) and one physician factor (older age) were significantly predictive of higher PEI score. CONCLUSION Provision of an intervention algorithm at each patient visit does not increase the likelihood that trained physicians who are cued to intervene will perform more of the intervention steps taught. Trained physicians are more likely to intervene with smokers who are more nicotine-dependent and who expect and desire to stop smoking.
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Affiliation(s)
- J K Ockene
- Department of Medicine, University of Massachusetts Medical School, Worcester
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11
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Richmond RL, Anderson P. Research in general practice for smokers and excessive drinkers in Australia and the UK. III. Dissemination of interventions. Addiction 1994; 89:49-62. [PMID: 8148744 DOI: 10.1111/j.1360-0443.1994.tb00849.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article reviews the main methods of dissemination of interventions to doctors for the benefit of patients who are smokers and excessive drinkers. Firstly, the modes of delivery of interventions are discussed such as: postal delivery, face-to-face strategies such as an educational facilitator, courier, training workshops, reinforcement contact after training, and teaching in medical school. Secondly, we examine GPs' delivery of interventions working in association with others such as with: the health visitor, health facilitator, practice nurse, and specialist clinic. Thirdly, we discuss the debate about the public health impact of GP interventions for smokers, which is about rates of recruitment of patients to programs and about the most effective interventions that will continue to be used by GPs. Fourthly, doctors underutilize their opportunities to identify and intervene with smokers and excessive drinkers and we explore many of the barriers to intervention. Finally, there are several new initiatives in general practice that require research including: matching GPs to specific treatments, comparing the uptake and continued use of different levels of interventions, evaluating the most effective ways of delivering interventions to GPs, and the training of doctors in the intervention methods.
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Affiliation(s)
- R L Richmond
- Brief Intervention Unit, University of New South Wales, Sydney, Australia
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12
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Sanders D, Peveler R, Mant D, Fowler G. Predictors of successful smoking cessation following advice from nurses in general practice. Addiction 1993; 88:1699-705. [PMID: 8130709 DOI: 10.1111/j.1360-0443.1993.tb02045.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
At follow-up of 751 subjects receiving a brief nurse-administered anti-smoking intervention in general practice, 135 subjects (18%) reported stopping smoking, of whom 44 (6%) reported sustained cessation for one year. The demographic, social and attitudinal characteristics of these subjects were compared with 616 subjects who continued to smoke. The most important predictors of cessation were intention to stop (OR 5.1, 95% CI 2.1-12.0), personal rating of likelihood of cessation (OR 4.9, 95% CI 2.8-8.5), nurse rating of likelihood of cessation (OR 4.0, 95% CI 2.2-7.4), and smoking habit of partner (1.9, 95% CI 1.3-2.9). As practice nurses are able to distinguish likely quitters from those who are not motivated and less likely to succeed, it is important to decide whether it is more cost effective to target support at the motivated or to spend more time encouraging less motivated. The most challenging, but possibly the most rewarding, task is to try to reduce the high proportion of new ex-smokers who relapse. Although 41.1% (95% CI 28.1, 58.0) of those expressing a definite intention to stop smoking gave up, only 17.9% (95% CI 8.9, 30.4) achieved sustained cessation. However, as sustained cessation is strongly predicted by social variables, such as marital status and time spent in the company of smokers, preventing relapse may not be easy to achieve through medical intervention alone.
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Affiliation(s)
- D Sanders
- Oxford University, Department of Psychiatry, Warneford Hospital, UK
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13
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Richmond RL, Kehoe LA, Webster IW. Multivariate models for predicting abstention following intervention to stop smoking by general practitioners. Addiction 1993; 88:1127-35. [PMID: 8401167 DOI: 10.1111/j.1360-0443.1993.tb02132.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Predictors of successful smoking cessation were examined in a randomized controlled trial of 450 smokers who received an intervention by their general practitioner (GP). Pretreatment characteristics predicting outcome at 3, 6 and 12 months and for continuous abstinence to 12 months were determined using logistic regression analyses. Results showed the variables that significantly predicted abstention at 3 months were age and motivation, whereas the predictors at 6 months were socio-economic status, motivation, level of dependence and time spent with smokers. No single predictor emerged at 12 months. Predictors for continuous abstinence to 12 months were age, time spent with smokers and motivation. A model was developed which best describes the likelihood of patients achieving continuous long-term abstinence. The results show that five factors (high motivation level, older age, less time spent with smokers, low dependence level, and higher socio-economic status) together have a 76% accuracy of predicting continuous abstinence to 12 months.
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Affiliation(s)
- R L Richmond
- School of Community Medicine, University of New South Wales, Australia
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14
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Goldberg RJ, Ockene JK, Kristeller J, Kalan K, Landon J, Hosmer DW. Factors associated with heavy smoking among men and women: the physician-delivered smoking intervention project. Am Heart J 1993; 125:818-23. [PMID: 8438711 DOI: 10.1016/0002-8703(93)90176-a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
As part of a randomized trial that compared the effects of three physician-delivered smoking interventions on patients' long-term cessation rates, we examined factors associated with the extent of baseline cigarette smoking separately in 546 men and 715 women who were enrolled in this trial. Several baseline characteristics were significantly related to heavier (> or = 25 cigarettes per day) smoking after controlling for a variety of factors in multivariate analyses, which were performed separately for men and women. Among both men and women, extent of addictiveness to smoking and number of cigarettes smoked during periods of heaviest smoking were significantly related to extent of current cigarette smoking (p < 0.001). In addition, among men shortness of breath, lack of previous attempts to quit and lack of confidence in their ability to stop smoking were significantly related to current heavy cigarette smoking (p < 0.05). The results of this study in ambulatory outpatients suggest a profile of heavy cigarette smokers that may be used for the more effective delivery of targeted smoking intervention efforts.
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Affiliation(s)
- R J Goldberg
- Department of Medicine, University of Massachusetts Medical School, Worcester 01655
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15
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Richmond RL, Makinson RJ, Kehoe LA, Giugni AA, Webster IW. One-year evaluation of three smoking cessation interventions administered by general practitioners. Addict Behav 1993; 18:187-99. [PMID: 8506790 DOI: 10.1016/0306-4603(93)90049-f] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Three smoking cessation interventions designed for use by general practitioners (GPs) within the routine consultation were evaluated in a field setting using 26 GPs throughout metropolitan Sydney. A total of 450 smoking patients were allocated to either Structured Behavioral Change with nicotine gum (Group SBCN), Structured Behavioral Change without nicotine gum (Group SBC), or GP advice with nicotine gum (Group AN). Although significant differences in the percentage of abstainers were observed between Groups SBCN and SBC three weeks after treatment (39% vs. 26%), the point prevalence abstinence rate for patients at 12 months declined to 19, 18, and 12% for Groups SBCN, SBC, and AN, respectively. Continuous abstinence to the end of the 12-month period was 9% for Groups SBCN and SBC, and 6% for Group AN. Forty-eight percent of the 450 patients made an attempt to stop smoking, and 89% reduced their cigarette consumption at some point during the study. Examination of 132 self-selecting patients who fully participated in the three interventions and attended all scheduled visits, revealed significantly larger proportions of abstainers within Groups SBCN (34%) and SBC (33%) than in Group AN (15%) at the 12-month follow-up.
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Affiliation(s)
- R L Richmond
- School of Community Medicine, University of New South Wales, Australia
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17
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Abstract
BACKGROUND A population-based sample of 893 white women ages 25 to 59 years from five San Francisco, California, Bay Area counties were queried about their demographic characteristics, height, reported weight at age 25, cigarette smoking history, and oral contraceptive and sunscreen use. METHODS Multiple logistic regression techniques were used to analyze the data. Forty-three percent of the women in the sample had never smoked more than 100 cigarettes, while 27% were current and 30% were former smokers. Separated or divorced women were more likely to have ever smoked. RESULTS Women who were less educated, single, separated, or divorced or had smoked between 10 and 30 cigarettes per day were less likely to quit smoking. Women with less education and a longer history of smoking smoked more cigarettes per day. Women who had never smoked were more likely to use sunscreen and to report their weight as slightly less at age 25 than were smokers.
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Affiliation(s)
- R E DuNah
- Department of Medicine, University of California San Francisco School of Medicine 94143
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18
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Goodman MT, Kolonel LN, Wilkens LR, Yoshizawa CN, Le Marchand L. Smoking history and survival among lung cancer patients. Cancer Causes Control 1990; 1:155-63. [PMID: 1966317 DOI: 10.1007/bf00053167] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Two population-based case-control studies of lung cancer were conducted on the Island of Oahu, Hawaii, between 1979 and 1985. Interview information concerning smoking habits and other characteristics was obtained from a total of 463 men and 212 women with histologically confirmed lung cancer. Records from the Hawaii Tumor Registry were reviewed for information on the stage, histology, and follow-up status of these patients. Cigarette smoking was found to be positively related to the age-adjusted risk of death among women (relative risk (RR) = 1.6; 95 percent confidence interval (CI) = 1.0-2.4), but not among men (RR = 0.8; 95 percent CI = 0.5-1.2). Among women, the age-adjusted median survival time for never smokers was 33 months (n = 53) compared with a median survival of 18 months (n = 159) for smokers. Both past and current female smokers were at greater risk of death than never-smokers, and there was a significant trend in the risk of death by the number of cigarettes smoked per day (P = 0.04), and the age at which the subjects started smoking (P = 0.01). The effects of tumor stage and histology upon the association between tobacco smoking and survival were also explored.
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Affiliation(s)
- M T Goodman
- Epidemiology Program, University of Hawaii, Honolulu 96813
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19
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Rimer BK, Orleans CT, Keintz MK, Cristinzio S, Fleisher L. The older smoker. Status, challenges and opportunities for intervention. Chest 1990; 97:547-53. [PMID: 2306958 DOI: 10.1378/chest.97.3.547] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Smoking is a significant cause of morbidity and mortality among older adults. Cessation of smoking benefits older adults almost immediately. Little is known, however, about how older adults quit and how to help them. No smoking cessation programs have been designed for this population. Here we report the findings of a random survey of American Association of Retired Persons members conducted to learn more about older smokers, their smoking and health characteristics, their quitting motivations and experiences, and the role of physicians' advice to quit. We obtained data on 339 current smokers aged 50 to 102. Current smokers were more likely to be heavy, highly addicted smokers. They also reported more smoking-related symptoms and conditions and fewer preventive tests and check-ups than never-smokers or former smokers. Although 44 percent of smokers were interested in quitting, only 39 percent reported that they had been advised to stop smoking by their physicians in the previous year. Physicians who treat older patients can have a significant impact on helping them to stop smoking by giving them a strong recommendation to quit and by providing appropriate interventions.
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Affiliation(s)
- B K Rimer
- Fox Chase Cancer Center, Philadelphia 19111
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20
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Abstract
Maintaining smoking abstinence after a myocardial infarction (MI) greatly reduces risks of recurrent disease morbidity and of mortality. Although post-MI patients appear to have better long-term rates of smoking abstinence compared with healthy groups, studies employing biochemical verification of smoking status generally indicate that only about one third of previously smoking post-MI patients remain abstinent at follow-up. Factors which may accompany the occurrence of a MI and which may be associated with maintenance of smoking abstinence include environmental changes aiding cessation (e.g., decreased exposure to smoking cues), increased social support from family, and stronger belief in the harmful effects of continued smoking. The usefulness of these factors in developing new treatments for maintaining abstinence in post-MI patients is discussed, and commonalities between efforts to maintain smoking abstinence in post-MI patients and avoidance of substance abuse in other groups at risk for serious health consequences are briefly noted.
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Affiliation(s)
- K A Perkins
- Western Psychiatric Institute & Clinic, University of Pittsburgh School of Medicine, PA 15213
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Ockene JK, Hosmer DW, Williams JW, Goldberg RJ, Ockene IS, Biliouris T, Dalen JE. The relationship of patient characteristics to physician delivery of advice to stop smoking. J Gen Intern Med 1987; 2:337-40. [PMID: 3655960 DOI: 10.1007/bf02596170] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To investigate the frequency of physician delivery of advice to stop smoking and patient characteristics affecting whether physicians deliver such advice, the authors surveyed 97 current cigarette smokers seen in two specialty and one general medicine clinic at a university medical center. Approximately two thirds of the smokers reported ever having been advised to stop smoking by their current physicians. In univariate and multivariate analyses, the presence of a smoking-related illness, the number of prior attempts to quit, and the duration of cigarette smoking were significantly related to delivery of smoking cessation advice by physicians. Knowledge of factors that affect the provision of advice to stop smoking can be used to enhance the physician's role in smoking intervention.
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Affiliation(s)
- J K Ockene
- Department of Medicine, University of Massachusetts Medical School, Worcester 01605
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